Randomized Controlled Trial of a Home‐Based Walking Program to Reduce Moderate to Severe Aromatase Inhibitor‐Associated Arthralgia in Breast Cancer Survivors

BACKGROUND: In postmenopausal women diagnosed with breast cancer (BC), most BC tumors are hormone receptor positive and guidelines recommend adjuvant endocrine therapy that includes an aromatase inhibitor (AI). This study investigates the impact of a 6-week, home-based, self-directed walking program on the commonly reported side effect of AI-associated arthralgia (AIAA). MATERIALS AND METHODS: In this phase II trial, consented BC patients were randomized to walking Intervention (n = 31) or Wait List Control (WLC; n = 31). Eligibility criteria included: stage 0-III BC, on AI for at least 4 weeks, ≥3 on a 5-point scale inquiring about joint symptom intensity "at its worst," and exercising ≤150 minutes per week. Outcomes were self-reported joint symptoms and psychosocial measures. Analyses comparing Intervention and WLC groups were conducted on an intention-to-treat basis to assess intervention impact at 6 weeks (postintervention) and at 6-months follow-up. Adjusted means were calculated to assess differences in two groups. RESULTS: In our final sample (n = 62), mean age was 64 years, 74% were white, and 63% had a body mass index of 30 or higher. At postintervention, Intervention group participants reported significantly increased walking minutes per week, reduced stiffness, less difficulty with activities of daily living (ADL), and less perceived helplessness in managing joint symptoms. At 6-months follow-up (postwalking period in both Intervention and WLC), walking minutes per week had decreased significantly; however, improvements in stiffness and difficulty with ADLs were maintained. CONCLUSION: This study adds to the growing evidence base suggesting exercise as a safe alternative or adjunct to medications for the management of AIAA. IMPLICATIONS FOR PRACTICE: Breast cancer survivors whose adjuvant endocrine treatment includes an aromatase inhibitor (AI) often experience the side effect of AI-associated arthralgia (AIAA). This study investigates the impact of a 6-week, home-based, self-directed walking program in the management of AIAA. Compared with Wait List Control, women in the Intervention group reported significantly increased walking minutes per week, reduced stiffness, less difficulty with activities of daily living, and less perceived helplessness in managing joint symptoms. This study adds to the growing evidence base suggesting exercise as a safe alternative or adjunct to medications for the management of AIAA

Evaluation of constitutive models for crushed salt

Three constitutive models are recommended as candidates for describing the deformation of crushed salt. These models are generalized to three-dimensional states of stress to include the effects of mean and deviatoric stress and modified to include effects of temperature, grain size, and moisture content. A database including hydrostatic consolidation and shear consolidation tests conducted on Waste Isolation Pilot Plant (WIPP) and southeastern New Mexico salt is used to determine material parameters for the models. To evaluate the capability of the models, parameter values obtained from fitting the complete database are used to predict the individual tests. Finite element calculations of a WIPP shaft with emplaced crushed salt demonstrate the model predictions

Most Common Single-Nucleotide Polymorphisms Associated With Rheumatoid Arthritis in Persons of European Ancestry Confer Risk of Rheumatoid Arthritis in African Americans

Objective. Large-scale genetic association studies have identified \u3e20 rheumatoid arthritis (RA) risk alleles among individuals of European ancestry. The influence of these risk alleles has not been comprehensively studied in African Americans. We therefore sought to examine whether these validated RA risk alleles are associated with RA risk in an African American population. Methods. Twenty-seven candidate single-nucleotide polymorphisms (SNPs) were genotyped in 556 autoantibody-positive African Americans with RA and 791 healthy African American control subjects. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for each SNP were compared with previously published ORs for RA patients of European ancestry. We then calculated a composite genetic risk score (GRS) for each individual based on the sum of all risk alleles. Results. Overlap of the ORs and 95% CIs between the European and African American populations was observed for 24 of the 27 candidate SNPs. Conversely, 3 of the 27 SNPs (CCR6 rs3093023, TAGAP rs394581, and TNFAIP3 rs6920220) demonstrated ORs in the opposite direction from those reported for RA patients of European ancestry. The GRS analysis indicated a small but highly significant probability that African American patients relative to control subjects were enriched for the risk alleles validated in European RA patients (P = 0.00005). Conclusion. The majority of RA risk alleles previously validated for RA patients of European ancestry showed similar ORs in our population of African Americans with RA. Furthermore, the aggregate GRS supports the hypothesis that these SNPs are risk alleles for RA in the African American population. Future large-scale genetic studies are needed to validate these risk alleles and identify novel RA risk alleles in African Americans

Use of Complementary and Alternative Medicine Among Patients With Arthritis

Introduction: Previous studies suggest that people with arthritis have high rates of using complementary and alternative medicine (CAM) approaches for managing their arthritis, in addition to conventional treatments such as prescription medications. However, little is known about the use of CAM by diagnosis, or which forms of CAM are most frequently used by people with arthritis. This study was designed to provide detailed information about use of CAM for symptoms associated with arthritis in patients followed in primary care and specialty clinics in North Carolina. Methods: Using a cross-sectional design, we drew our sample from primary care (n = 1,077) and specialist (n = 1,063) physician offices. Summary statistics were used to calculate differences within and between diagnostic groups, practice settings, and other characteristics. Logistic regression models clustered at the site level were used to determine the effect of patient characteristics on ever and current use of 9 CAM categories and an overall category of "any use." Results: Most of the participants followed by specialists (90.5%) and a slightly smaller percentage of those in the primary care sample (82.8%) had tried at least 1 complementary therapy for arthritis symptoms. Participants with fibromyalgia used complementary therapies more often than those with rheumatoid arthritis, osteoarthritis, or chronic joint symptoms. More than 50% of patients in both samples used over-the-counter topical pain relievers, more than 25% used meditation or drew on religious or spiritual beliefs, and more than 19% used a chiropractor. Women and participants with higher levels of education were more likely to report current use of alternative therapies. Conclusion: Most arthritis patients in both primary care and specialty settings have used CAM for their arthritis symptoms. Health care providers (especially musculoskeletal specialists) should discuss these therapies with all arthritis patients

IUD self-removal as self-care: Research is needed in low and middle-income countries

The ability to freely decide one’s number, spacing, and timing of children has been highlighted as a human right in international declarations and research, policy, and programmatic efforts in family planning. Accessing and using one’s preferred contraceptive method is also a crucial component of ensuring people’s reproductive autonomy or empowerment. The publication of the World Health Organization (WHO)’s updated Guidelines on Self-Care for Sexual and Reproductive Health and Rights (SRHR) in 2019 highlighted that self-care interventions for SRHR might be particularly important in supporting people’s free, full, and informed-decision making. These guidelines underscore that while self-care may facilitate more individual control over one’s own reproductive health, these approaches are embedded within larger health systems. Therefore, self-care suggests a balance between supporting people’s autonomy as active participants in their own reproductive health decisions, while acknowledging that people may still desire support from healthcare providers. This balance is particularly important for people who may be marginalized, as a result of discriminatory gender norms or unequal power in families or intimate relationships, or gender and sexualminorities. Somemembers of these groupsmight welcome self-care to reduce exposure to less-supportive health systems, while others might appreciate more structured care

Physical activity and osteoarthritis:A consensus study to harmonise self-reporting methods of physical activity across international cohorts

Physical activity (PA) is increasingly recognised as an important factor within studies of osteoarthritis (OA). However, subjective methods used to assess PA are highly variable and have not been developed for use within studies of OA, which creates difficulties when comparing and interpreting PA data in OA research. The aim of this study was, therefore, to gain expert agreement on the appropriate methods to harmonise PA data among existing population cohorts to enable the investigation of the association of PA and OA. The definition of PA in an OA context and methods of harmonization were established via an international expert consensus meeting and modified Delphi exercise using a geographically diverse committee selected on the basis of individual expertise in physical activity, exercise medicine, and OA. Agreement was met for all aims of study: (1) The use of Metabolic Equivalent of Task (MET) minutes per week (MET-min/week) as a method for harmonising PA variables among cohorts; (2) The determination of methods for treating missing components of MET-min/week calculation; a value will be produced from comparable activities within a representative cohort; (3) Exclusion of the domain of occupation from total MET-min/week; (4) The need for a specific measure of joint loading of an activity in addition to intensity and time, in studies of diseases, such as OA. This study has developed a systematic method to classify and harmonise PA in existing OA cohorts. It also provides minimum requirements for future studies intending to include subjective PA measures

Client and therapist views of contextual factors related to termination from psychotherapy: A comparison between unilateral and mutual terminators

Contextual variables potentially influencing premature termination were examined. Clients (n = 83) and therapists (n = 35) provided parallel data on early working alliance, psychotherapy termination decision (unilateral vs. mutual), clients’ reasons for termination, and barriers to treatment participation. When clients unilaterally ended therapy, therapists were only partially aware of either the extent of clients’ perceived improvements or their dissatisfaction. When termination was mutually determined, there were no differences between client and therapist ratings of termination reasons. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by clients and therapists, all clients rated the early alliance and barriers to treatment more highly than did therapists. Results have implications for understanding premature termination and suggest future research examining the utility of therapist feedback regarding contextual variables in terms of retaining clients in therapy

Oxidation of automotive primary reference fuels at elevated pressures

Automotive engine knock limits the maximum operating compression ratio and ultimate thermodynamic efficiency of spark-ignition (SI) engines. In compression-ignition (CI) or diesel cycle engines, the premixed burn phase, which occurs shortly after injection, determines the time it takes for autoignition to occur. In order to improve engine efficiency and to recommend more efficient, cleaner-burning alternative fuels, they must understand the chemical kinetic processes that lead to autoignition in both SI and CI engines. These engines burn large molecular-weight blended fuels, a class to which the primary reference fuels (PRF) n-heptane and iso-octane belong. In this study, experiments were performed under engine like conditions in a high-pressure flow reactor using both the pure PRF fuels and their mixtures in the temperature range 550-880 K and 12.5 atm pressure. These experiments not only provide information on the reactivity of each fuel but also identify the major intermediate products formed during the oxidation process. A detailed chemical kinetic mechanism is used to simulate these experiments, and comparisons of experimentally measured and model predicted profiles for O{sub 2}, CO, CO{sub 2}, H{sub 2}O and temperature rise are presented. Intermediates identified in the flow reactor are compared with those present in the computations, and the kinetic pathways leading to their formation are discussed. In addition, autoignition delay times measured in a shock tube over the temperature range 690-1220 K and at 40 atm pressure were simulated. Good agreement between experiment and simulation was obtained for both the pure fuels and their mixtures. Finally, quantitative values of major intermediates measured in the exhaust gas of a cooperative fuels research engine operating under motored engine conditions are presented together with those predicted by the detailed model

Oxidation of automotive primary reference fuels in a high pressure flow reactor

Automotive engine knock limits the maximum operating compression ratio and ultimate thermodynamic efficiency of spark-ignition (SI) engines. In compression-ignition (CI) or diesel cycle engines the premixed urn phase, which occurs shortly after injection, determines the time it takes for autoignition to occur. In order to improve engine efficiency and to recommend more efficient, cleaner-burning alternative fuels, we must understand the chemical kinetic processes which lead to autoignition in both SI and CI engines. These engines burn large molecular-weight blended fuels, a class to which the primary reference fuels (PRF), n-heptane and isooctane belong. In this study, experiments were performed under engine-like conditions in a high pressure flow reactor using both the pure PRF fuels and their mixtures in the temperature range 550-880 K and at 12.5 atm pressure. These experiments not only provide information on the reactivity of each fuel but also identify the major intermediate products formed during the oxidation process. A detailed chemical kinetic mechanism is used to simulate these experiments and comparisons of experimentally measures and model predicted profiles for O{sub 2}, CO, CO{sub 2}, H{sub 2}O and temperature rise are presented. Intermediates identified in the flow reactor are compared with those present in the computations, and the kinetic pathways leading to their formation are discussed. In addition, autoignition delay times measured in a shock tube over the temperature range 690- 1220 K and at 40 atm pressure were simulated. Good agreement between experiment and simulation was obtained for both the pure fuels and their mixtures. Finally, quantitative values of major intermediates measured in the exhaust gas of a cooperative fuels research engine operating under motored engine conditions are presented together with those predicted by the detailed method